胃壁固定术为基础的内镜下胃造瘘术  

Clinical application of endoscopic gastrostomy based on gastric wall fixation

作　　者：钟永锋[1] 范利好[1] 阮妮 杨灵[3] 刘金秀[1] 刘翠玲[1] 

机构地区：[1]中山市陈星海医院内镜中心,528415 [2]中山市东凤人民医院内科,528425 [3]中山市黄圃人民医院外科,528429

出　　处：《现代消化及介入诊疗》2017年第1期13-16,共4页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：中山市科技计划项目(No.20132A034)

摘　　要：目的以胃壁固定术为基础,通过扩大胃造瘘口,直接置入更大尺寸胃造瘘管。方法采用多中心前瞻性研究,选择有PEG指征的50例患者,分为A、B两组,A组25例采用胃壁固定术及胃造瘘穿刺针穿刺造瘘口,通过血管钳扩大胃造瘘口,置入18 Fr胃造瘘管;B组25例采用24 Fr的带针胸管作造瘘口穿刺,置入18 Fr胃造瘘管。比较两组患者术中及术后并发症、胃造瘘操作时间、患者术前1 d与术后第14天的营养指标等。结果两组患者术中及术后均无并发症发生;B组操作时间更短,差异有统计学意义(P<0.05);两组术后第14天营养指标均有改善,与术前比较差异有统计学意义(P<0.05);术后营养指标两组间比较,差异无统计学意义(P>0.05)。结论以胃壁固定术作为胃造瘘术的基础,可根据患者实际需要置入不同尺寸的胃造瘘管,患者及其家属经胃造瘘管输注营养物的依从性得以提高,有利于患者的康复。Objective On the basis of gastric wall fixation, by expanding the gastric fistula, directly implant a larger size of gastric fistula tube. Method We selected 50 patients with PEG indications who were randomly divided into group A and group B, with 25 patients in each group. Patients in group A were treated by gastric wall fixation and gastrostomy with puncture needle, expanded gastric fistula by hemostat, and then implanted a 18 Fr gastric fistula tube; Patients in group B were punctured using a 24 Fr Thoracic puncture tube with needle, and implanted a 18 Fr gastric fistula tube. Intraoperative and postoperative complications, operation time, and nutrition conditions before and after operation were compared. Rusult Two groups had no intraoperative and postoperative complications; The operation time in group B was shorter than that in group A（P〈0.05）; Compared with preoperative nutritional index, nutrition conditions at 14 th day after operation were significantly improved in two groups（P〈0.05）, while there was no statistically significant difference as for postoperative nutritional index between two groups（P〈0.05）. Conclusion Endoscopic gastrostomy based on gastric wall fixation could implant different sizes of gastric fistula tube according to actual needs.

关 键 词：胃壁固定术 内镜 胃造瘘术 胃造瘘管 

分 类 号：R656.61[医药卫生—外科学]